The unpopular service user: communication principles

The unpopular service user• The follow-on from stigmatisation and stereotyping is our response to

these prejudices.

• So, if we expect someone to be difficult and we are suspicious of them, they will be defensive with us and be who we expect them to be.

• It is not surprising that practitioners can gain a negative view of people who are intoxicated on alcohol or drugs. Their behaviour is often challenging, especially in A&E on a busy night shift when there are ‘more deserving’ people who need attention, or when their behaviour is putting a dependent at risk of harm.

• The notion of the ‘unpopular patient’ has been around since 1970s and applies to many groups of health service users: older people, drug users, mothers who reject their babies, sex offenders, etc

The unpopular service user (Greenwood 1992)

A specific study of GP attitudes to drug users identified aspects of drug users that practitioners found difficult:

Communication problems

• Users can have difficulty communicating. They may have poor education, limited vocabulary, and low self esteem.

• Longer-term substance users may be cognitively impaired, affecting their comprehension and memory.

• It helps to remember that they may be more scared of you than you are of them!

The unpopular service user (Greenwood 1992)

Lacking skills to help

• Practitioners who don’t specialise in substance misuse may feel they don’t have the skills to deal with what appears to be a complex need.

• The service user may have more knowledge of services and treatment than the practitioner – at least they may appear to have.

• Own up! It is a great way to empower the service user and make you listen to them. Ask them what it means, how they see things, what impact it has, and so on.

• You will have the knowledge you need to help this person in some way.

The unpopular service user (Greenwood 1992)

Feeling deceived

• Practitioners tend not to trust drug users. There are stories that they complain of pain simply to get more opiates. They try to get prescriptions when they can’t get street drugs.

• More likely, it is the service user who doesn’t trust the practitioner. They may be very anxious about suffering withdrawal symptoms because health practitioners tend to take control away from them. In social care, this distrust may be due to fear of having children removed, or the police being involved.

• Desperation and suspicion may make anyone feel they need to manipulate the situation. Try to empower them by giving them choices.

The unpopular service user (Greenwood 1992)

Disillusionment

• We can feel overwhelmed by the needs of someone who has complex psychosocial problems. Where do we start with someone who is homeless, has Hepatitis B and a heroin habit?

• Practitioners are all human and need to feel they can ‘do good’ but drug or alcohol dependent service users can make us feel defeated.

• It helps if we try to focus on an immediate need we can meet rather than all of them. Sometimes that immediate need is simply to be listened to.

Case study - Jim• Jim is a injecting drug user admitted to general

surgical ward for an abscess. He has a central line to deliver antibiotics but is seen to be ‘fiddling’ with it.

• Staff get suspicious he is using it to inject heroin smuggled in by friends, so they move him next to the nurses’ station.

• Jim worries about being observed so closely so scratches the site of his central line more covertly. The itching is really bothering him but staff won’t believe him when he says it itches.

• The poor trust between the nurses and the patient in this case led to poor care for Jim and a breach of his dignity by being observed so closely.

• Drug service liaison between the ward sister and Jim helped both understand the others’ concerns. Jim was moved away from the nurses’ station and he was given cream to reduce the irritation. He was also given information explaining why he shouldn’t disturb the central line.

The unpopular service user (Maben, 2013)

• It is also important that staff are supported to deliver quality care to patients, clients, service users.

• Maben (2013) found that staff who were not looked after were more likely to distance themselves from patients and deliver lower quality care.

• Issues such as low staff levels, poor organisational support and low job satisfaction were factors in linking staff wellbeing and patient care.

ReferencesGreenwood (1992) ‘Unpopular patients: GPs’ attitudes to drug users.’ Cited in Druglink, Jul/Aug 2013, 8-10.

Maben (2013) ‘How NHS staff wellbeing affects patient care.’ Hospital Service Journal. Accessed 16.7.15. available at: http://www.hsj.co.uk/home/innovation-and-efficiency/how-nhs-staff-wellbeing-affects-patient-care/5057528.article#.ValS76RViko